Ambulance management of patients with penetrating truncal trauma and hypotension in Melbourne, Australia

Eva Rosenbaum, Shelley Cox, Karen Smith, Mark Fitzgerald, George Braitberg, Anthony Carpenter, Stephen Bernard

Emerg Med Australas 2020 Apr;32(2):336-343

Objective: Penetrating truncal trauma with hypotension is uncommon in Australia. Current pre- hospital clinical practice guidelines based on overseas studies recommend expedited transport to definitive trauma care and that i.v. fluid should only be administered to maintain palpable blood pressure.

Methods: A retrospective review included all adult patients with penetrating truncal trauma and hypotension (systolic blood pressure <90 mmHg) attended by emergency medical services in Victoria between January 2006 and December 2018. Patient pre-hospital characteristics and hospital outcomes are described using descriptive statistics. Predictors of fluid resuscitation and mortality were examined using logistic regression analyses.

Results: Between 2006 and 2018 there were 101 hypotensive, penetrating truncal injury major trauma patients in Melbourne, Victoria transported by road ambulance to a major trauma service. The median age of these patients was 38 years (interquartile range [IQR] 27-50) and 85% were male. Median scene time was 16.6 min (IQR 12-26) and median pre-hospital time was 53.0 min (IQR 38-66). Intravenous fluid resuscitation was given in 54.5% of cases. The mechanism of injury was stabbing in 91.1% and gunshot wound in 8.9%. Urgent surgery was required in 72.3% of cases, 32.7% of patients were admitted to the intensive care unit and there were eight deaths (8.3%).

Conclusion: Penetrating truncal trauma with hypotension is rare in Melbourne, Australia with most patients having the injury caused by stabbing rather than shooting. Compared with outcomes reported in the USA and Europe, the mortality rate is low.